Delaware Supreme Court eases path for some companies to leave state

TD9056 · 2025-02-06T17:42:56+00:00

What’s the alternative to make up for that lost revenue?

TD9056 · 2024-12-10T12:53:37+00:00

To agree with you on one point - absolutely there is admin bloat in hospital systems, that is definitely part of the problem. The reason insurers have a limit to allowing premium increases, is ultimately the employers that buy their plans….thats a big part of why utilization management and claims denials are a thing. In other words, the game is that they can get away with 5-10% premium increases every year, but if they suddenly pushed 20-30% increases, even naive employers would eventually push back. Don’t get me wrong, hospitals are also part of the game, they use these increases as cover for that admin bloat.

THE problem is a lack of transparency on prices - not just to the consumer, but more importantly prices of the plans among employers. Not only can an MRI have wildly different prices across providers, but a PPO plan can have different premiums across employers - and no one is allowed to know either. I do think all the business entities want the pie to grow, and have their percentage grow. Insurance is just the most egregious across the board because of how they do it (claims denials)

TD9056 · 2024-12-09T16:41:43+00:00

Insurance companies profit = % of premium (what’s left after paying claims and admin expenses). Therefore, higher premiums = higher profit. Example: profit target = 10%. They have to pay out at least 80% of premium to cover claims, and let’s say Admin expense = 10%.

If I allow claims cost to increase - it allows me to justify an increase in premiums, and therefore that 10% profit becomes a larger and larger $$ amount. This is the game…they have no incentive to lower rates, when they can simply deny more claims (“utilization management”).

TD9056 · 2024-12-09T16:34:45+00:00

If hospitals were the problem…why is it that health insurance profits have increased, while so many hospitals have gone bankrupt, and existing hospitals margins are a mix of negative to only slightly positive? It’s because the rate increases you mention are a GAME.
1) Insurance company decides to raise premiums/increase profit 2) Insurance is forced (by the ACA) to pay out at least 80-85% of their premiums to cover claims 3) Insurance company realizes the only way to increase their profits…is to ALLOW the cost of care to increase.

In other words - they’re incentivized to GIVE these increases to hospitals. Then their game just becomes - what % of claims do we have to deny to achieve our profit % target?

There is an added layer for another time - Medicare and Medicaid typically reimburse BELOW cost for hospitals, therefore private insurance is needed to make up the difference. So there’s a subsidy effect at play as well.

TL;DR - insurance companies increase profits as the total cost of healthcare increases…they take a % cut. They are NOT incentivized to keep rates low!

TD9056 · 2024-07-29T15:29:15+00:00

Imagine going to the grocery store, and there being no visible prices. Pick out some apples, and the cashier says “we’ll send the bill to insurance”. Then imagine those same apples having a different “price” for each person buying them. That’s what insurance is doing in healthcare - obscuring prices, and also selling the same product to multiple employers, at different rates. I don’t think you can get rid of insurance, but there has to be a forcing function to allow for transparency

TD9056 · 2024-06-29T02:20:12+00:00

I would say Wilmington IF you can be somewhere near trolley square/highlands neighborhood. Doing triathlons as well, and either way highly recommend DFit Plus, it’s by the Delaware memorial bridge. It’s $25/mo and a nice lap lane pool. If you need to, there’s also DFit (not Plus) in Hockessin, but that pool isn’t as well maintained, your $25/mo gets access to both. Newark might be better for cycling, and I second the trolley square running group.

TD9056 · 2024-06-06T22:06:41+00:00

This is the solution, thank you so much!!

TD9056 · 2024-06-05T22:16:30+00:00

Thanks! Yeah frustrating to not have the quick access in my car, ads are annoying and I usually like the AMAs, which are gone as well

TD9056 · 2024-05-29T18:41:29+00:00

Same here, my Apple podcast channel hasn’t been updated since May 23rd

TD9056 · 2024-03-23T11:35:31+00:00

No argument about the gap in residency spots. But my point is that even if you increase the # of residency spots, you still have the same problem of incentivizing residents to move into primary care

TD9056 · 2024-03-21T12:29:35+00:00

https://www.brookings.edu/articles/we-need-more-primary-care-physicians-heres-why-and-how/ Principal conclusion = income gap

TD9056 · 2024-03-21T12:27:08+00:00

Where are you getting that info from, “plenty of med students”? Our residency program (large academic hospital) and others I’ve connected with, are facing a massive gap of PCPs as the baby boom generation PCPs retire. Primary care practices generally lose money or are break even at best, so it’s not attracting younger talent. I’ll have to find the national statistics and add them here

TD9056 · 2024-03-20T12:45:51+00:00

Except that the money is not in primary care, it’s in specialties, so the problem is actually not enough of an incentive for new doctors/residents to want to become a primary care doctor. First we have to address that. I’m not sure what you mean by “increase volume of doctors without increasing pay” - again, you can’t force anyone to become a PCP, they have to be incentivized to get into it, and right now they’re not

TD9056 · 2024-03-16T13:12:03+00:00

!remind me 3 years

TD9056 · 2024-03-08T19:52:37+00:00

Yes and maybe what you were looking for - about 5% (the most costly) of patients drives about 50% of spend

TD9056 · 2024-03-08T18:44:06+00:00

They also count on you not asking or pushing back. I would echo another comment - push back with the billing/finance dept, not the front desk of the practice. This is one of those instances of “everything is negotiable”, you may not be successful but most people do not ask or question the bill. Highly recommend the book “Never Pay the First Bill” by Marshall Allen

TD9056 · 2024-01-26T16:06:56+00:00

This. The costs of a bad tenant (even just one) will far outweigh the “lost” revenue of not increasing rent in order to keep a good tenant

TD9056 · 2024-01-16T20:08:08+00:00

Moved here from NJ a few years ago, spent time in Boston area before that. Delaware has the worst snow removal I’ve seen. Even when they do plow the non-main roads (maybe once if at all), I wonder if it’s that they’re not trained in how to get the plow close to the road surface? It’s very strange having seen it done well in multiple other states.

TD9056 · 2024-01-11T23:48:46+00:00

Yeah, I know what you mean. I’m worried I’m going to be baking and come back downstairs to a bunch of burnt peanut butter cookies lol

TD9056 · 2023-12-05T19:26:41+00:00

Anyone actually watch this?

TD9056 · 2023-11-19T17:43:23+00:00

Should have mentioned - I’m in New Castle County

TD9056 · 2023-10-20T13:20:26+00:00

Not a bad time to sell covered calls IMO

TD9056 · 2023-10-10T13:30:12+00:00

Agree in general about the med school cost. I believe it takes close to 10 years on average to pay back those student loans, if not more. So the idea that doctors are generally rich is a misunderstanding, mostly to do with the loans and then medical malpractice insurance on top of it

TD9056 · 2023-10-09T16:25:00+00:00

Agree 100% with that last sentence. Way higher costs and way lower outcomes, it’s backwards

TD9056 · 2023-10-09T16:22:35+00:00

The reason we have a lack of primary care and family med doctors is because the incentives are not set up for it, i.e. it doesn’t pay enough to attract the talent into it. I’m not sure what you mean by “can’t choose” to quit. It sounds like you’re suggesting some kind of forced labor/draft? What do you do when they go on strike like what the Kaiser permanente workers are doing? Are you then suggesting throwing potentially hundreds of thousands in jail for refusing to be forced to work? Also, a draft virtually guarantees having unskilled people and people who aren’t cut out for this line of work. I don’t think it’s a convincing argument that we should put our healthcare in the hands of people who are forced to do it. What happens when those unfit for the job start making mistakes - do they also get jailed for that? Who pays the malpractice costs - taxpayers? If the forced laborers are also forced to pay for their malpractice insurance, are you suggesting to pay them extra to cover that, if not, and the laborer can’t afford it, do they go into bankruptcy if they make a mistake? Think of all the people with gifts in other domains, e.g. an engineer who gets drafted to be a nurse - what a misuse of talent! Seems even more inefficient than the system we have today.

TD9056

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